02/28/2020 03:15 PM LABOR & COMMERCE

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HB 91-NATUROPATHS: LICENSING; PRACTICE3:47:45 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 91, "An Act relating to the practice of
naturopathy; relating to the licensure of naturopaths; relating
to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
3:48:11 PM
REPRESENTATIVE JENNIFER JOHNSTON, Alaska State Legislature,
recounted that years ago, her father-in-law was the driving
force in getting osteopaths hospital privileges. She shared a
personal anecdote about her daughter. She went on to say that
this bill gives Alaskans an affordable alternative to primary
care and that naturopaths have the education and training to
provide the practice outline in this bill. She noted that the
proposed prescriptive authority in HB 91 excludes controlled
substances and chemotherapy drugs. She expressed her hope that
the committee will listen to the forthcoming testimony and that
they will pass the bill out of committee.
3:50:29 PM
REPRESENTATIVE STUTES noted that after speaking with Ms. Shine,
she was reassured about several issues regarding prescriptive
authority. She asked Ms. Shine to elaborate.
3:51:00 PM
ERIN SHINE, Staff, Representative Jennifer Johnston, Alaska
State Legislature, recounted that Naturopathic doctors are
educated in pharmacology throughout various courses during their
four-year medical school. She said that although their school
is similar to that of medical doctors (MDs), they diverge in
some training. She highlighted that for naturopaths (NDs),
their education and training is the same or more than health
professionals who are practicing with a broader scope of
practice than this bill provides.
CHAIR SPOHNHOLZ clarified that nurse practitioners receive
either a master's degree or a doctorate, which is between six
and eight years of school.
MS. SHINE acknowledged that.
3:52:39 PM
REPRESENTATIVE FIELDS said that he is "between a rock and a hard
place" because trusted doctors have strongly opposed it, but he
would like to support his colleague. He asked if there is an
opportunity for consensus on a narrow expansion of authority for
naturopaths.
REP JOHNSTON opined that it is already narrow. She reiterated
that the bill excludes controlled substances and chemotherapy
drugs. She said it allows naturopaths to prescribe cold
medication for their patients, for example. Furthermore, she
added that because they are naturopaths, they're less likely to
write prescriptions.
CHAIR SPOHNHOLZ noted that they have received 31 letters of
opposition and 116 in support of HB 91.
3:54:44 PM
REPRESENTATIVE STUTES asked if any of the "nightmare" stories
heard during the bill's previous period of public testimony have
been substantiated.
MS. SHINE said no. She explained that after hearing the
testimony last year, she followed up with Sarah Chambers, the
Director of the Division of Corporations, Business, and
Professional Licensing, and not one of those stories has been
reported or investigated in Alaska. She said it's quite
possible that those are stories coming from outside Alaska in
states that are unregulated where people can call themselves
naturopaths and potentially operate like a naturopath. She
reiterated that those claims have never been substantiated
throughout the years that this bill has been before the
legislature.
3:55:36 PM
REPRESENTATIVE STORY reported concerns about naturopaths
identifying themselves differently than doctors.
MS. SHINE replied that she did a deep dive into other states and
how they've outlined titles for naturopaths and other health
care professionals. Of the states that regulate, there are many
that put a prohibition on using the word "physician." In HB 91,
it does remove the current prohibition from the 1986 statutes
that were put into place. In states that do allow naturopaths
to call themselves naturopathic physicians, they also recommend
that they must identify that they are a "naturopathic physician"
instead of just "physicians" to prevent confusion for patients.
CHAIR SPOHNHOLZ clarified that the title "doctor" is short for
"doctorate," which many people hold. She added that it is
colloquially used because historically, medical doctors were the
primary care givers; however, that is no longer true.
3:58:16 PM
REPRESENTATIVE HANNAN inquired as to the level of concern about
naturopaths' licensure.
3:58:57 PM3`
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, replied that the Division of Corporation,
Business, and Professional Licensing does not see many problems
concerning licensed naturopaths. She offered her belief that
the department averages approximately 7 investigations every 10
years. Furthermore, last year there was only one complaint that
was not followed through with. She stated that naturopaths do
not have a problematic profession.
3:59:51 PM
REPRESENTATIVE HANNAN asked of the professional licensure boards
that the department currently oversees, how many include
prescriptive authority.
MS. CHAMBERS listed the State Medical Board, the Board of
Nursing, the Board of Dental Examiners, the Board of Veterinary
Examiners, and the Board of Examiners in Optometry.
REPRESENTATIVE HANNAN asked how often there are investigations
of a disciplinary nature into those boards with prescriptive
authority and whether there are associated prescriptive
problems. She contemplated whether giving naturopaths
prescriptive authority should be a legitimate concern.
MS. CHAMBERS acknowledged the nationwide concern about
controlled substances. She reassured the committee that there
is nothing in the bill that would give naturopaths even the
illusion of having the ability to prescribe controlled
substances. She reiterated that this would match the state law
with their training.
4:02:57 PM
REPRESENTATIVE STORY reported that medical professionals are
concerned about naturopaths being inexperienced.
4:03:26 PM
CHAIR SPOHNHOLZ sought clarification on the complaint that was
filed and not followed through with. She asked what that means.
MS. CHAMBERS explained that there was nothing to pursue because
the person lost interest or didn't take the complaint seriously
enough to pursue.
4:06:09 PM
CHAIR SPOHNHOLZ opened public testimony.
4:06:31 PM
ALEX MALTER, Alaska State Medical Association, stated that his
purpose in testifying is to respectfully urge the committee not
to support expanding the scope of practice for naturopaths under
HB 91. He opined that these changes would not enhance patient
care or improve Alaskans' access to care. He shared a brief
history of his medical background and a personal anecdote. He
reiterated his belief that expanding naturopaths' scope of
practice would not enhance medical care in Alaska or improve
patient access. He offered his understanding that medical
training for naturopaths is less rigorous than that of medical
doctors. He said its emphasis in alternative healing does not
allow adequate time for students to study the accepted pathology
and physiology to safely treat most medical conditions. In
general, medical doctors don't believe that the first two
didactic years of naturopath school and medical school are
comparable, he said. Furthermore, he argued that even if they
are similar, medical students are still required to spend an
additional four years in clinical training or residency before
being licensed in the state of Alaska. Under HB 91, he said,
naturopaths could be licensed to prescribe with less training,
little of which being focused on relative pharmaceutical
treatments. To conclude, he said it's unlikely that expanding
the scope of practice for naturopaths will improve access to
care for the underserved. He urged the committee to vote no on
HB 91.
4:11:34 PM
REPRESENTATIVE HANNAN declared a conflict of interest, as Mr.
Malter has been her primary care physician for the last 25
years.
4:12:02 PM
KATHERINE BROWN, noted that she is the great-niece of Dora
Sweeney an elected delegate to the state constitutional
convention, representing Juneau from 1955-1965 in the
territorial and state legislatures. She stated that NDs receive
the same training as MDs for the first two years of their
education, focusing on natural medicine afterwards. She said
they are fully qualified to function as primary care physicians
and to competently perform minor surgeries and prescribe certain
medications. She offered her belief that not taking advantage
of the full capacities of Alaska's NDs "is madness." She added
that if stories of malpractice by naturopaths are not documented
and legally reported as required by law, they have no place in
the present discussion. All Alaskans should have access to
[naturopathic] care if they so choose, she opined. To conclude,
she asked members to pass HB 91 out of committee.
4:15:08 PM
MARY FOLAND, MD, State Medical Association, stated that she
opposes the expansion of practice. She reported that the State
Medical Board has opposed this legislation, adding that the
board believes these changes are the practice of allopathic
medicine and are not appropriate or safe for the public. She
indicated that she is privy to substantiated stories and
proceeded to share one about malpractice committed by a ND. She
went on to say that HB 91 would allow NDs to prescribe
potentially dangerous pharmaceuticals including cardiac
antiarrhythmics, antipsychotics, blood thinners, or amino
suppressants, as well as contraceptive devices, which are
implanted under the skin or inside the uterus and carry the risk
of infection and uterine perforation. It would also allow NDs
to order diagnostic procedures, she stated. She urged the
committee to act to protect the health and safety of Alaskan
patients by not passing the bill.
CHAIR SPOHNHOLZ asked if Dr. Foland reported the naturopath from
her story.
DR. FOLAND answered no. She said she heard the story from a
physician that was sharing the results of an endometrial biopsy
with a patient. She alleged that she knows of a different case
that was investigated by the State Medical Board because the
investigator called her about "a naturopath who did have a
complication injecting phenol for back pain," resulting in the
patient's collapsed lung. She declined to share the name of the
naturopath who was allegedly involved.
4:19:37 PM
REPRESENTATIVE HANNAN asked if the endometrial cancer case
involved a naturopath practicing in the state of Alaska.
DR. FOLAND said yes.
REPRESENTATIVE HANNAN asked if the aforementioned case took
place in Alaska.
DR. FOLAND answered yes.
REPRESNTATIVE HANNAN asked if doctors have a legal duty to
report medical incompetence if they encounter it while treating
a patient.
DR. FOLAND offered her understanding that reports to the State
Medical Board and to the State Medical Association's grievance
committee must come from the patient, not the physician.
CHAIR SPOHNHOLZ asked Ms. Chambers to clarify who should submit
the report.
4:20:49 PM
MS. CHAMBERS said anyone can file a complaint, adding that the
division would do the investigation by interviewing both the
doctor and patient. Some health care professions require the
report of sexual abuse or child abuse, she explained. She
offered her belief that there is no requirement to report a
medical procedure that didn't work out.
CHAIR SPOHNHOLZ repeated that if there are people practicing
health care in an unsafe manner, there is a process by which
health care providers should take action on to ensure that the
public is safe.
4:22:21 PM
PATRICK NOLAN, MD, informed the committee that he is a board-
certified internist and endocrinologist. He said he is
testifying in opposition to HB 91 for several reasons. He
argued that NDs don't have the same education as osteopathic or
allopathic physicians and for that reason, should stick to
naturopathy. He opined that they should not be allowed to
prescribe drugs because they are not adequately trained. He
stated that the complexity of medicine has increased
tremendously in the last 40 years, adding that NDs need more
specialized medical training.
4:26:40 PM
RHENE MERKOURIS, MD, Alaska State Medical Association, reported
that she is an obstetrician-gynecologist, adding that she is
speaking against HB 91. She argued that medical schools are
accredited through standardized tests that guarantee a base of
knowledge, whereas naturopaths do not have these types of tests.
In comparison, she said, there's no question about the ability
to diagnose disease, perform surgery, or [prescribe] medication.
She shared a personal anecdote. She stated that she speaks
strongly against HB 91 for these reasons.
4:30:07 PM
JOHN DEKEYSER, MD, informed the committee that he is a medical
doctor and is board certified in family practice, as well as
obstetrics and gynecology. He addressed different aspects of
the Naturopathic Physicians Licensing Exam (NPLX) and shared
several anecdotes.
4:33:53 PM
JEFFERY DEMAIN, MD, offered his belief that naturopaths provide
a good service, enhance the wellness of patients, and treat "the
whole person." He said he also co-manages patients with NDs.
Nonetheless, he opined that their therapies and approaches to
diagnostic management are inconsistent with evidence-based
principles. He further stated that they are counter to
scientific evidence of standard care. As a result, he said he
has seen patients misdiagnosed and mismanaged completely. He
addressed the difference in education between MDs and NDs. He
voiced his opposition to HB 91, adding that it would put
Alaskans at risk and would add to the shortage of health care in
the state.
4:37:04 PM
REPRESENTATIVE HANNAN questioned whether Dr. Demean has ever
seen his patients misdiagnosed from previous medical doctors.
DR. DEMAIN said misdiagnosis is infrequent and shared anecdotal
examples.
4:39:55 PM
AMY SEIBERLICH, ND, Alaska Association of Naturopathic
Physicians, provided a history of her education through college
and her work experience beginning in Fairbanks as a naturopathic
doctor. She recounted helping patients with food addictions
lose a significant amount of weight through finding and treating
underlying medical conditions, implementing a whole foods diet,
targeted nutrient replacement, and a lot of counseling. Along
with the wight loss, she reported regularly seeing their blood
pressures drop by 40 points, cholesterol levels decrease by
half, and blood sugars normalize within weeks; however, because
of the current scope of practice she is forced to refer these
patients elsewhere to manage their medication. She said that
like other MDs, she is trained to manage these medications and
if she were to practice somewhere else, she could easily and
safely do so. This discrepancy costs Alaska qualified primary
care providers, which lowers health care access and competition,
while driving up costs. HB 91 seeks to correct this, she said,
and she encouraged the committee to pass it.
4:43:14 PM
ADAM GROVE, ND, noted that he is a naturopath practicing in
Anchorage and is also certified as a brain injury specialist by
the Brain Injury Association of America. He shared a
description of his educational background and early work
experience, as well as personal anecdote about his work with
brain injuries in Alaska. He said he runs into problems in
rural areas because without prescriptive rights he cannot manage
medications or provide the guidance to those who might be on the
wrong medications. He concluded by offering his belief that
naturopaths are more equipped to provide care for complex issues
like brain injury. He urged the passage of HB 91 and stressed
that naturopaths are a valuable asset to Alaska and expanding
their privileges to manage medication through prescription is
essential.
4:47:53 PM
DOUG VERMILLION, MD, stated that he is a medical doctor in
Anchorage and is having trouble getting patients cleared for
surgery and making sure their optimized. He said there are not
enough primary care doctors and that more access to primary care
would benefit the residents of Alaska. As far as being
credentialed, he said, it can be worked out. He offered his
belief that Alaskan citizens need additional access to primary
care and many [naturopaths] are very good.
4:49:04 PM
JOSHUA GREEN, ND, informed the committee that he is a
naturopathic physician in the state of Vermont and the president
of the Vermont Association of Naturopathic Physicians. He said
he is calling in support of HB 91. He provided a brief history
about the licensure of naturopaths in Vermont. He addressed
several claims in the testimony put forth by physicians and
their opposition to the bill. He pointed out that NDs have
additional training in mechanical medicine, homeopathy, diet and
lifestyle counseling, which is different than most physicians.
To conclude he said NDs refer to other specialists often, as
appropriate, and are referred by other specialists. He said he
is thankful to have opening prescribing rights in Vermont and
expressed his hope that Alaska is open to that as well.
CHAIR SPOHNHOLZ noted that HB 91, as proposed, would not allow
for open prescribing rights in the state of Alaska.
4:53:51 PM
COURTNEY BOWERS, ND, provided a history of her education through
college and her work experience in Vermont as a ND in primary
care. She acknowledged the lack of residencies available in
[naturopathic] education, which lead her to create her own. She
addressed several concerns voiced by earlier testifiers,
stressing that as a ND in primary care, she would never implant
an intrauterine device (IUD) or prescribe anti-cancer drugs or
heart failure drugs, because all require specialists. She said
she doesn't get the sense that's what Alaskan naturopaths are
asking for - they are asking for a formulary that is appropriate
to the scope in which they are trained. That is what they do in
Vermont and it's been working very well, she added.
4:57:16 PM
REPRESENTATIVE HANNAN asked if Dr. Bowers prescribes birth
control.
DR. BOWERS said yes, adding that she is very well trained in
oral contraceptive. She reiterated that she does not implant
IUDs, instead opting to refer those patients to gynecologists or
Planned Parenthood for the consultation and application. Other
than oral contraceptive, she noted that she can prescribe
diaphragms and spermicide.
REPRESENTATIVE HANNAN asked if Dr. Bowers does Norplant
implants.
DR. BOWERS answered no.
4:58:39 PM
DANIEL YOUNG, ND, said he has been practicing naturopathic
medicine for 28 years, four of which have been in Eagle River.
He voiced his support for HB 91. He shared his belief that it's
a good bill and that it's reasonable to allow trained
naturopathic doctors for what they're asking for in this
legislation. He summarized the licensure process for NDs in
Alaska. It requires accreditation and passing the NPLEX
professional board exams, which are rigorous and contain a minor
surgeries module, as well as a pharmaceutical module. He
explained that the U.S. Department of Education oversees the
accreditation of naturopathic medicine just as well as they do
allopathic and osteopathic medicine. He said that for years,
naturopaths have been trying to educate the legislature on what
they can provide to Alaskans. He added that NDs have an
excellent safety record. He urged the members to pass HB 91 out
of committee.
5:02:10 PM
GARY FERGUSON, ND, informed the members that he is a
naturopathic doctor in the state of Alaska. He said he went to
naturopathic medical school because he believes in wholistic
based approaches and indigenous based approaches to healing,
which includes botanical and physical medicine. He stated that
he supports HB 91. He stated that naturopaths pass a stringent
licensing exam. He went on to say that without the ability to
prescribe they can't help patients appropriately manage their
medications. He said HB 91 would allow NDs to practice how they
were trained. He shared a personal anecdote and said, being a
Native Alaskan person, he sees the need for culturally based
approaches that NDs can bring to Alaskans.
5:05:53 PM
ANNETTE O'CONNELL shared an anecdote about her personal battle
with celiac disease and how a ND was the first doctor to
accurately diagnose and treat her. She revealed that because of
Alaska's current laws, she must travel outside of the state to
receive the care she has come to trust and the medications for
her thyroid condition. She asked the committee to "stop this
vendetta the medical establishment has against any other
profession that impedes on their territory." They believe they
are the only branch of the medical professionals that are
qualified to offer services and that others are not safe, she
said. She made several observations on statements made by
previous testifiers. She concluded by urging the committee to
pass HB 91.
5:08:54 PM
DAVID SCHLEICH noted his credentials. He pointed out that there
is an uneven and inadequate understanding of naturopathic
training and credentialing. He said the growth in the activity
of naturopathic professionals has been remarkable in the last 20
years and that it's a very good idea to support and enhance the
managing of medications within the scope for Alaska's
naturopathic professionals, as outlined in HB 91. He went to
explain that naturopaths go through programmatic accreditation,
as well as state and regional accreditation. He encouraged
allopathic and biomedicine professional colleagues to become
more familiar with the rigor, depth, and extent of naturopathic
practice and training - particularly to the training and
education.
5:13:52 PM
NATALIE WIGGINS, ND, informed the committee that she is a
naturopathic physician practicing in Anchorage Alaska. She
voiced her support for HB 91. She shared an anecdotal example
illustrating how the lack of prescriptive rights impacts her
ability to treat her patients. She stated that naturopaths are
highly trained to maintain medication and she urged the
committee to support this bill.
5:16:20 PM
CAMERON O'CONNEL, read the following statement:
I'm writing in support of House Bill 91 and I am a
naturopathic doctor. Born and raised in Alaska, I
hoped to come back to the state once I had finished my
medical training and residency to set up a practice
and give back to the greater Anchorage community. The
decision was not easy. My residency was in California
and as such, I had prescription rights. Having to
give up the ability to do something as simple as put
my patients on (indisc.) for hypothyroidism made my
move back to Alaska a much more difficult decision
than it should have been. A few examples of how this
limited scope of practice has impacted my ability to
provide care. A woman came into my office and she had
fears about vaccination and subsequently had not
vaccinated her children. I alleviated those fears and
she agreed to get her children vaccinated. However, I
was unable to write a prescription or provide any
vaccines in my office. An opportunity was missed to
give treatment and this, from a public health
perspective, is a poor outcome. I have a patient with
a lower respiratory infection come into my office, and
I provided the naturopathic standard of care including
informing the patient when she would need to progress
from conservative treatment to pharmaceuticals. The
patient was discouraged to find she would have to pay
another large fee to go to an Urgent Care or another
provider to receive basic antibiotic therapy if the
need arose. In closing, please consider updating our
bill to a more modern scope that lets us utilize all
of our training. The statute that governs my
profession was passed in 1987. I was born in 1982.
I've grown a lot in 32 years and so should our
legislation.
MS. O'CONNEL said the last time she testified residency has was
a hot topic. She explained that she was overseen by three
medical doctors and one naturopathic doctor.
5:18:49 PM
VICKI KENNEDY said she is overwhelmingly in support of HB 91.
She declared that nearly 400 medical doctors were put in prison
for overwriting opioid prescriptions in the last eight years.
Nonetheless, she went on to say that most medical doctors are
phenomenal; however, they are in the pockets of "the big
pharma." She reiterated her support for HB 91.
5:20:23 PM
CHAIR SPOHNHOLZ closed public testimony and announced that HB 91
was held over.